Choosing the right lens implant is one of the most important decisions you’ll make during cataract surgery. In this video, Dr. Keith Skolnick explains the different types of intraocular lens options available, including monofocal, multifocal, toric, and advanced specialty lenses. He walks through how each lens works, who may benefit most from each option, and why these choices can have a lasting impact on your vision after surger

Hi, I’m Dr. Keith Skolnick. I’m one of the eye surgeons at the Fort Lauderdale Eye Institute, and I specialize in cataract surgery. Today, I’m going to discuss cataract surgery—specifically, the types of lens implants that can be used to replace your cataract.

A cataract is simply a clouding of your lens. The natural lens you were born with can become cloudy over time, and when that happens, it needs to be replaced. We replace it with an artificial lens. The artificial lens is similar to a contact lens in that it has built-in power, a built-in prescription, and built-in optical capabilities. It replaces your natural lens and is permanent.

Because of this, whatever decision you make during cataract surgery is a permanent one.

The standard lens, which has been used for about 75 years, is called a monofocal lens. A monofocal lens is a single-focus lens. If you have a monofocal lens implanted and it is set for distance vision, there is a chance you will see well at distance without glasses. However, you will need glasses for up-close tasks because it is only a single-focus lens, typically set for distance.

Alternatively, the lens can be set for near vision, which allows you to read without glasses, but then you would need glasses for distance. If you want both distance and near vision, your cataract can be replaced with a multifocal lens. A multifocal, or multi-focus, lens is analogous to a trifocal or progressive lens, allowing vision across a full range.

Many patients—most patients, in fact—who receive a multifocal lens do not need glasses after surgery. About one out of ten patients may still need glasses for certain very specific tasks.

Another type of lens we can implant is called a toric lens, spelled T-O-R-I-C. A toric lens corrects astigmatism. Many patients are born with astigmatism, which is related to the shape of the eye. I can implant a lens that neutralizes or treats the astigmatism you were born with, resulting in a better visual outcome.

Toric lenses are available in both monofocal, or single-focus, varieties, as well as multifocal versions. You can have a monofocal toric lens or a multifocal toric lens. Non-toric versions of these lenses are also available for patients who do not have significant astigmatism. If you have a small degree of astigmatism, it can sometimes be treated with a femtosecond laser, which is used during cataract surgery.

There are a few other lens options that are more specific.

One is called the Apthera lens, or APTHERA. I typically use this lens for patients who have had previous LASIK surgery, laser vision correction, or radial keratotomy in the 1980s and 1990s. This lens is usually placed in the non-dominant eye and can provide an extended depth of focus, or a broader range of vision. It functions similarly to a multifocal lens but is specifically designed for patients who have had prior laser vision correction or LASIK.

Typically, the Apthera lens is placed in the non-dominant eye, while a single-focus lens is placed in the dominant eye to provide better distance vision.

The final lens option is called the Light Adjustable Lens, or LAL, formerly known as the Calhoun lens. This lens is adjustable after it has been implanted. We place the lens in the eye, and afterward, a series of light treatments are used to adjust the refractive result of the lens.

This is a very time-intensive option and requires more postoperative visits than other lens choices. However, it can be an excellent option for patients who want to fine-tune or adjust their vision after surgery.

Thank you.